Author Interviews, NEJM / 07.03.2015

Michael D Hill, MD MSc FRCPC Calgary Stroke Program Professor, Dept Clinical Neurosciences Hotchkiss Brain Institute University of Calgary, Cumming School of Medicine Foothills Hospital, Calgary, CanadaMedicalResearch.com Interview with: Michael D Hill, MD MSc FRCPC Calgary Stroke Program Professor, Dept Clinical Neurosciences Hotchkiss Brain Institute University of Calgary, Cumming School of Medicine Foothills Hospital, Calgary, Canada Medical Research: What is the background for this study? What are the main findings? Dr. Hill: Major ischemic stroke with blocked proximal arteries results in 60-80% death and disability.  Recent studies of endovascular treatment were neutral.  Evolution of technology has resulted in advances in the devices.  Key features of past trials of endovascular therapy were, underdeveloped imaging paradigms for patient selection, slow treatment times and poor reperfusion rates. Medical Research: What should clinicians and patients take away from your report? Dr. Hill: Simply, endovascular therapy for major ischemic stroke over and above best medical care (ie. IV tPA) is effective . It reduces disability and saves lives.  The NNT is very low 4, making it one of the largest proven effect sizes in all of medicine.  BUT, it applies only under selected conditions. (more…)
AHA Journals, Author Interviews, Stroke, UCLA / 15.02.2015

Dr. May Nour MD PhD Neurology Fellow UCLA MedicalResearch.com Interview with: Dr. May Nour MD PhD Neurology Fellow UCLA Medical Research: What is the background for this study? What are the main findings? Dr. Nour: In October of 2014, results from the MR CLEAN trial were the first to demonstrate better functional outcomes in stroke patients as a result of endovascular therapy. Among patients whose stroke was caused by clot blocking a large vessel responsible for delivering blood to the vital tissue of the brain, the use of endovascular therapy, primarily utilizing second-generation clot retrieval devices, showed improved outcomes in most cases evaluated in combination with medical therapy, when compared to medical therapy alone. Currently, the standard of care involves delivery of intravenous tissue plasminogen activator (IV tPA) within a short time window (up to 3-4.5 hrs) with the intention of dissolving, rather than physically removing the clot as in the case of endovascular retrieval. (more…)
Author Interviews, NEJM, Stroke / 12.02.2015

MedicalResearch.com Interview with: Dr Bruce Campbell MBBS(Hons), BMedSc, PhD, FRACP Consultant Neurologist, Head of Hyperacute Stroke Department of Neurology     Royal Melbourne Hospital NHMRC Early Career Research Fellow Melbourne Brain Centre @ RMH Department of Medicine University of Melbourne Australia MedicalResearch: What is the background for this study? What are the main findings? Dr. Campbell: EXTEND-IA was a randomised trial comparing standard thrombolysis with tPA plus endovascular stent-thrombectomy versus tPA alone in ischemic stroke patients selected for the presence of major vessel occlusion and salvageable brain tissue using CT perfusion imaging. It was designed in 2011 at a time when there was uncertainty about the effectiveness of endovascular therapy which deepened in 2013 with the publication of 3 neutral trials. The recent publication of the Dutch MR-CLEAN study showing improved outcomes with stent-thrombectomy was a major advance and prompted a data safety and monitoring committee review of the EXTEND-IA data leading to early termination of the trial for efficacy.
The key findings from EXTEND-IA were that the addition of stent-thrombectomy to tPA led to a dramatic increase in restoration of blood flow to the brain from 34% to 89%. This translated to markedly improved outcomes at 3 months with 71% of stent-thrombectomy patients compared with 40% of tPA-only patients regaining independence. The 3 trials released today were remarkably consistent in their outcomes and this provides a solid evidence base to recommend stent-thrombectomy as the new standard of care for patients with large vessel ischemic stroke.
Patients who were treated with stent-thrombectomy in EXTEND-IA had more than double the rate of reperfusion (restoration of blood flow to the brain) compared to the standard tPA patients and this translated to a 31% absolute increase in the proportion of patients living independently at 3 months. (more…)